| NPI | 1104145978 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GERALD R WERTH Owner 612-767-5966 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207QA0401X Family Medicine, Addiction Medicine (Licence: MN 1782) |
| Enumeration Date | 2010-05-19 |
| Last Update Date | 2010-05-19 |